Tuesday, October 27, 2009

Psychotropic Drugs and Indigent Funerals

If you haven't figured out by now, the Chicago Tribune is a fantastic newspaper and an integral part of my de-stressing routine. Their investigations and news stories never cease to impress me. Today was no exception. The latest Tribune Watchdog investigation regarding compromised care focused on Illinois nursing home residents who receive psychotropics they don't want or need. Part One: Drugged Without Cause ran today and tomorrow I'll post Part Two: Doctors' role in misuse of psychotropics. The article is heavy with incidences of nursing home residents who were given psychotropics without a doctor order, without giving consent, or without a medical or mental health need. I cringed a little bit when I read the headline, fearing that people will read the article and have a knee-jerk reaction. The truth is some people need psychotropics and should stay on them. Not every nursing home or nursing home employee makes such poor decisions, nor do all doctors needlessly order psychotropics. However, it is good for us to be aware that these situations happen and to work to ensure that they do not happen anymore. Medication should not be the first measure, as the article notes. Patients with certain behaviors, anxieties, fears, should be redirected, offered a snack (I get cranky when I'm hungry too!), or involved in an activity (boredom could make even a saint act out.) What bothers me is how employees and nursing homes rationalized such poor practice. Just read this particular example:

At VIP Manor near St. Louis in 2006, a woman with Alzheimer's cried and became extremely anxious when she had to urinate. She also repeatedly asked to go to the bathroom. Nurses responded by giving her injections of two antipsychotics, inspection reports state. When that didn't work, the woman was sent to a hospital for a psychiatric evaluation. The psychiatrist reported back that the woman had a urinary tract infection. VIP Manor's nursing director, whom the report did not identify, told state inspectors that her staff was still learning to look for medical issues before administering psychotropics.
"We aren't there yet, but close," she said.

As my blog's title states, I'm a social worker, not a nurse. But even I know from reading that if the patient cried and became extremely anxious when needing to urinate and requested to go to the bathroom repeatedly, it just might indicate a UTI. How on earth could they have missed that? Why would a psychotropic be the first response and why would it come before a psych eval? And why would medical health professionals need to be trained to look for medical issues before resorting to psychotropics? It just doesn't make sense. I look forward to reading Part Two tomorrow and hope that this investigation will lead to change.

Another interesting article concerned the rise in indigent burials, by 30%, in Chicago this past year. Indigents are buried in Homewood Memorial Gardens, if they have not been identified or if family cannot be found or do not have funds (or are unwilling) to pay for burial. Some financial assistance is available. For people who were on or were eligible for public aid, Illinois Department of Human Services reimburses funeral homes or the family after the funeral, allowing $500 for burials and $1,100 for funerals. The Cook County Veterans Assistance Commission buries any honorably discharged indigent veteran, up to $600. Homewood buries indigents at a cost of $235 per body. What is impressive is that they do not just bury these people, they also memorialize them and allow mortuary school students to participate in the process. Consider these words: "We do not know the circumstances in their lives that brought them to this grave," said Kowalski, also an instructor at Worsham College of Mortuary Science. "Many may have died in poverty, others may have simply outlived their families. Our beginnings do not know our ends."

1 comment:

Wellescent Health Blog said...

It is unfortunate that so little effort is sometimes directed at solving the problems of the elderly and that drugs are too often applied as the solution. Such situations are likely to arise when staff are poorly educated for the work, overworked or stressed out and unfortunately this sort of situation is only going to get worse with an increasing percentage of the population entering nursing homes.